Colon surgery at busier hospitals may lead to better recovery

NEW YORK (Reuters Health) - People who have colon surgery at
high-volume hospitals are more likely than patients at smaller
ones to go straight home for recovery without needing special
care, according to a large new study.

There are many ways to gauge the success of a surgery. Being
able to perform daily activities and get around independently
after the procedure is as important as surviving and avoiding
complications, senior author Dr. Daniel Anaya told Reuters
Health.

Recovery often takes a while after colorectal surgery, and
understanding the recovery process is important to making it
better, said Anaya, from Baylor College of Medicine in Houston.

"Our goal is to identify what the high-volume hospitals are
doing differently from other hospitals that lead to improved
outcomes," lead author Dr. Courtney J. Balentine, also from
Baylor, said.

"Once we figure out why some hospitals do better than
others, we can help every hospital adopt the practices that
really work so that all patients get the best outcomes no matter
where they have the operation."

The researchers divided more than 1,000 U.S. hospitals into
thirds based on how many colon surgeries were performed at each
facility in 2008. They called the top tier "high-volume"
hospitals and the bottom tier "low-volume."

The surgeries included operations for colon cancer and for
non-cancerous polyps or blockages, for instance.

Three quarters of the 280,000 patients included in the study
were operated on at high-volume hospitals. They tended to be
younger, have higher incomes and have private insurance more
often than their low-volume counterparts.

Less than half of all patients had complications following
surgery, regardless of where they were treated.

At busier hospitals, 86 percent of colon surgery patients
were discharged straight home, compared to 76 percent of those
treated at less busy hospitals.

Twenty percent of high-volume hospital patients ended up
using home healthcare services and 14 percent went to skilled
rehab facilities instead. At low-volume hospitals, the reverse
was true: more patients used skilled recovery facilities than
home healthcare after surgery.

Heading home after surgery indicates recovery is going well,
and most patients prefer to return home as soon as possible,
Balentine told Reuters Health.

Previous studies have found patients at high-volume
hospitals tend to do better in a number of areas than those at
low-volume hospitals, the researchers noted in JAMA Surgery. For
instance, a smaller fraction of patients die during the month
after surgery at busier hospitals.

Patients have a lot to think about when approaching surgery,
Dr. Farhood Farjah, associate medical director of the Surgical
Outcomes Research Center at the University of Washington in
Seattle, said. He was not involved in the new study.

"People who need to have colorectal surgery should ask their
surgeon several important questions," Farjah said, like about
the risks and benefits of surgery, ways to mitigate risks and
potential alternatives.

They should also ask about typical recovery patterns and
what they can do leading up to surgery to maximize their chances
of getting home afterward, he told Reuters Health.

"Examples of things to do include stop smoking and increase
activity and exercise," he said. "Also, patients should consider
what support they have in terms of family and friends in the
event that they need care when they go home."

The new results don't mean patients should only choose busy
hospitals for their surgeries - skilled surgeons can be found
anywhere, Anaya said.

"Just because your surgeon works at a hospital that doesn't
do many colorectal procedures, it doesn't mean that your surgeon
isn't qualified or won't do a good job," he said. "We just
showed that, overall, hospitals with higher volumes of
colorectal surgeries tend to produce better outcomes, in regards
to the postoperative recovery process."

He and others are in the process of investigating what it is
about the infrastructure or process at higher-volume hospitals
that leads to better recovery. Once they have figured out the
answer, Anaya thinks it will apply to all patients, from young
to old and urban to rural. But elderly patients may benefit the
most, since they are most likely to end up in rehab facilities.